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Survival Of Pediatric Patients Undergoing Cardiac Re-transplantation In The United States: Analysis Of United Network Of Organ Sharing - Organ Procurement & Transplantation Network (UNOS-OPTN) Data
Dhaval Chauhan, J. Hunter Mehaffey, J. W. Awori Hayanga, Jai Udassi, Vinay Badhwar, Christopher E. Mascio.
West Virginia University, Morgantown, WV, USA.
Objective(s): To evaluate post-operative survival of cardiac re-transplantation in the pediatric population in the United States.
Methods: United Network of Organ Sharing - Organ Procurement & Transplantation Network (UNOS-OPTN) data was analyzed for pediatric cardiac transplantation patients for first and second time from January 2006 to September 2023. Factors impacting post-transplant all-cause mortality were identified. Patients were stratified by re-transplant within first year following initial transplant vs. after first year of transplant. Kaplan Meier curves were derived. Multivariable Cox-Proportional Hazards model was created to evaluate impact of re-transplantation on all-cause mortality.
Results: A total of 7,314 pediatric heart transplants were performed with 337 patients undergoing cardiac re-transplantation. Cardiac re-transplantation was independently associated with increased post-transplant all-cause mortality (HR 2.26, p<0.001, 95% CI 1.81-2.83). The post-transplant survival at 1,2,5 and 10 years was 92%, 89%, 83% and 74% for patients with first transplant and 90%, 86%, 74% and 55% for patients with re-transplant respectively. Re-transplant survival was worse if it was performed within 1 year of transplant. (Figure 1)
Conclusions: Cardiac re-transplantation in pediatric population is associated with high long-term mortality. Nevertheless, survival for re-transplant is above 50% at 10-year follow-up with worse survival if re-transplant was done within first year of transplant. These data may be helpful in counselling parents seeking early transplantation rather than palliative/definitive operations in their children’s early life.
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